[squirlkeeperCCRN]

Call me crazy, but I have decided to retest rather than get ceu's to re-up my ccrn certification. I did ceu's the first time I renewed, but feel like studying and retesting will give me the knowledge that I want. I'm nervous about hemos however as we rarely use swans anymore. Not using that information daily has lead to me losing everything I once knew...normal values, calculations etc. A big part of the test did require use of this information to get the right answer. My question is, do other hospitals still use swans alot? How can I prepare for this portion of the test? Back when I originally tested every other patient in our unit had a swan...now, maybe one every 4 months or so. Any advice?

[Chisca]

If you are referring to pulmonary artery catheters, yes, they are still in use as they provide lots of useful information. Probably the best book I've read on hemodynamics and interpreting the information obtained from invasive catheters is Thomas Ahrens' Hemodynamic Waveform Analysis. If you grasp the concepts of preload, afterload, and contractility you have enough to pass the CCRN exam.


http://www.amazon.com/Hemodynamic-Wa...0617330&sr=1-7

[putmetosleep]

Originally Posted by squirlkeeperCCRN

Call me crazy, but I have decided to retest rather than get ceu's to re-up my ccrn certification. I did ceu's the first time I renewed, but feel like studying and retesting will give me the knowledge that I want. I'm nervous about hemos however as we rarely use swans anymore. Not using that information daily has lead to me losing everything I once knew...normal values, calculations etc. A big part of the test did require use of this information to get the right answer. My question is, do other hospitals still use swans alot? How can I prepare for this portion of the test? Back when I originally tested every other patient in our unit had a swan...now, maybe one every 4 months or so. Any advice?

In my SICU, we use swans all the time. ALL of our open heart pts come back with them (although I understand this is a trend that is dying), and any patient who becomes seriously compromised will most likely be swanned. I'm interested to find out the general consensus on how often swans are used elsewhere (esp for heart pts) across the country. I'm practicing in MN. I understand your wanting to re-test for the CCRN if you don't see swans regularly...I'm currently studying and scheduled to take the exam in Feb (fingers crossed!). I'm using Lauren Gasparis' DVD CCRN review to study (referrred to me through this website, thanks guys!) and have found it very useful so far. You can order it on www.greatnurses.com

[RN_inTexas]

I work in the MSICU of a hospital with a Level I Trauma designation. I have seen one swan on my unit in the two years I have been there, and heard of one in the Trauma ICU. There is a push to use the Vigileo system with a standard art line, but it has yet to be used on my unit.

The only unit that uses swans more than once a year is the CCU where all open hearts have a swan.

[hikergurl24]

We only see PA catheters for our postop ruptured AAA's, otherwise we never see them anymore.

[squirlkeeperCCRN]

thanks everyone! I have passed the test once (and think I am capable...come he** or high water). I too agree that Laura Gasparis is the way to go...good luck to you (and me).

[putmetosleep]

Originally Posted by RN_inTexas

I work in the MSICU of a hospital with a Level I Trauma designation. I have seen one swan on my unit in the two years I have been there, and heard of one in the Trauma ICU. There is a push to use the Vigileo system with a standard art line, but it has yet to be used on my unit.

The only unit that uses swans more than once a year is the CCU where all open hearts have a swan.

I do remember hearing a little bit about the Vigileo about a year ago. What measurements are you able to monitor with the system?

[nurseabc123]

Originally Posted by putmetosleep

I do remember hearing a little bit about the Vigileo about a year ago. What measurements are you able to monitor with the system?

We use the vigileo on all our TVR patients and other patients where a swan is contraindicated. So we have it maybe once every couple months. All off our cabgs, valves, sick AAA's have swan's. The Vigileo is based on radial artery waveform - enough said; we know how soon those can crap out on you. You calculate SV/SVI (C)CO/CI, SVR/SVRI, every 20 seconds. Not Scvo2/Svo2 - we don't have the additional equipment for it, but you can with a some sort of light oximetry probe.

[cardiacRN2006]

We've had 2 swans in the past 2 years at our ICU-both cardiac pts.

[Nurseboy1]

I helped put a swan in last 2 months ago. The patient had both septic shock and cardiogenic shock in multisystem failure.